Donepezil
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Acute cholinergic syndrome and sinus bradycardia: case report An 80-year-old woman developed acute cholinergic syndrome and sinus bradycardia during treatment with donepezil for Alzheimer’s disease (AD). The woman with AD presented to the emergency centre and poison centre of a hospital 15 hours following the last ingestion of 10mg donepezil when she was found to be unresponsive by a caregiver. She had been receiving famotidine, magnesium oxide and sennosides for chronic constipation and chronic gastritis. Approximately 7 years prior to the presentation, she was diagnosed with moderate AD and was prescribed oral donepezil tablet 5 mg/day. Two months before the presentation, dose of donepezil was increased to 10 mg/day as her AD symptoms became severe. She constantly received a donepezil tablet once a day at 08:00 hours. A few days following dose increase of donepezil to 10 mg/day, her family found out that she was sleeping most of the time. On admission at about 11:00 hours, she was comatose and had miosis. A physical examination showed enhanced bowel sounds. Initial blood tests were insignificant except for low serum albumin levels. CT of the brain showed moderate brain atrophy. A provisional diagnosis of acute cholinergic syndrome secondary to donepezil use was made. The woman was treated with fluid infusion. After admission, she gradually developed sinus bradycardia, which reduced to 45 beats/min 8 hours following admission. Owing to the absence of life-threatening symptoms, supportive treatment was continued. As she became alert, the pulse rate slowly returned to normal, and all other symptoms disappeared 20 hours following admission, and 22 hours after admission, she was discharged. To determine whether acute cholinergic syndrome was a consequence of an adverse reaction or poisoning, her blood samples were analysed by liquid chromatography-tandem mass spectrometry. Serum donepezil concentrations at 15, 18, and 35 hours following the last ingestion of donepezil were 13.8, 11.1, and 9.0 ng/mL, respectively. There were two distinct serum elimination half-lives: 9.5 hours (between 15 and 18 hours following the last ingestion) and 56 hours (between 18 and 35 hours following the last ingestion). Hanazawa T, et al. Acute cholinergic syndrome in a patient taking the prescribed dose of donepezil for Alzheimer’s disease Psychogeriatrics 20: 538-539, No. 4, Jul 2020. 803499464 Available from: URL: http://doi.org/10.1111/psyg.12531
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Reactions 5 Sep 2020 No. 1820
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